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Recent Changes to the PEHP Preferred Drug List

The Preferred Drug List includes prescription medications that have been chosen by PEHP's Pharmacy and Therapeutics Committee -- a team of local physicians, nurses, and pharmacists -- to be available at a lower Copayment. The committee chooses medications that provide the best value based on quality, safety, effectiveness and cost. The Preferred Drug List is modified periodically with changes based on recommendations from the committee.

Below are the most recent updates to the Preferred Drug List.

DRUG NAME EFFECTIVE DATE ACTION COVERAGE PREFERRED DRUG LIST RECOMMENDATIONS
EVISTA 1/1/2009 DELETION TIER 3 ALENDRONATE, TAMOXIFEN
TRICOR 1/1/2009 DELETION TIER 3 FENOFIBRATE
BAYER TEST STRIP 1/1/2009 DELETION TIER 3 ACCU-CHEK, ONETOUCH
PROVENTIL HFA 1/1/2009 DELETION TIER 3 PROAIR HFA, XOPENEX HFA
LEVAQUIN 1/1/2009 DELETION TIER 3 AVELOX
EXFORGE 1/1/2009 DELETION TIER 3 BENICAR, MICARDIS AND AMLODIPINE
XOPENEX SOLUTION 1/1/2009 DELETION TIER 3 ALBUTEROL SOLUTION
PULMICORT 1/1/2009 DELETION TIER 3 ASMANEX, FLOVENT, QVAR
TEKTURNA 1/1/2009 DELETION TIER 3 BENICAR, MICARDIS, COZAAR
TEKTURNA HCT 1/1/2009 DELETION TIER 3 BENICAR HCT, MICARDIS HCT, HYZAAR
DIOVAN 1/1/2009 DELETION TIER 3 BENICAR, MICARDIS, COZAAR
DIOVAN HCT 1/1/2009 DELETION TIER 3 BENICAR HCT, MICARDIS HCT, HYZAAR
ATACAND 1/1/2009 DELETION TIER 3 BENICAR, MICARDIS, COZAAR
ATACAND HCT 1/1/2009 DELETION TIER 3 BENICAR HCT, MICARDIS HCT, HYZAAR
FOSAMAX D 1/1/2009 DELETION TIER 3 ALENDRONATE
PROTONIX 1/1/2009 ADDITION TIER 2  
PANTOPRAZOLE 1/1/2009 DELETION NO COVERAGE PROTONIX
IMITREX INJ 1/1/2009 DELETION TIER 3 SUMITRIPTAN
ASCENSIA TEST STRIP 1/2/2009 DELETION TIER 3 ACCU-CHEK, ONETOUCH
IMITREX TABLETS 1/15/2009 DELETION TIER 3 SUMITRIPTAN
ZERIT 1/15/2009 DELETION TIER 3 STAVUDINE
RISPERDAL-M 3/15/2009 DELETION TIER 3 RISPERIDONE ODT
AMPHETAMINE MIXED ER 4/1/2009 DELETION NO COVERAGE ADDERALL XR
SIMCOR 5/1/2009 ADDITION TIER 2  
RENVELA 5/15/2009 ADDITION TIER 2  
TOPAMAX 5/15/2009 DELETION TIER 3 TOPIRAMATE
SIMPONI* 6/1/2009 ADDITION TIER 4  
NAMENDA* 6/15/2009 ADDITION TIER 2  
PRISTIQ* 6/15/2009 ADDITION TIER 2  
RETIN-A MICRO* 7/1/2009 DELETION TIER 3 TRETINOIN
AVANDIA 7/1/2009 DELETION TIER 3 ACTOS
AVANDARYL 7/1/2009 DELETION TIER 3 DUETACT
AVANDAMET 7/1/2009 DELETION TIER 3 ACTOPLUS MET
PROTOPIC 7/1/2009 DELETION TIER 3 ELIDEL
FROVA 7/1/2009 DELETION TIER 3 SUMITRIPTAN, MAXALT, RELPAX
AMERGE 7/1/2009 DELETION TIER 3 SUMITRIPTAN, MAXALT, RELPAX
ZOMIG 7/1/2009 DELETION TIER 3 SUMITRIPTAN, MAXALT, RELPAX
NASACORT* 7/1/2009 DELETION TIER 3 FLUTICASONE, FLUNISOLIDE, NASONEX
RHINOCORT* 7/1/2009 DELETION TIER 3 FLUTICASONE, FLUNISOLIDE, NASONEX
VERAMYST* 7/1/2009 DELETION TIER 3 FLUTICASONE, FLUNISOLIDE, NASONEX
NUTROPIN* 7/1/2009 DELETION TIER 4 HUMATROPE, GENOTROPIN, NORDITROPIN
TEV-TROPIN* 7/1/2009 DELETION TIER 4 HUMATROPE, GENOTROPIN, NORDITROPIN
OMNITROPE* 7/1/2009 DELETION TIER 4 HUMATROPE, GENOTROPIN, NORDITROPIN
SAIZEN* 7/1/2009 DELETION TIER 4 HUMATROPE, GENOTROPIN, NORDITROPIN
SEROSTIM* 7/1/2009 DELETION TIER 4 HUMATROPE, GENOTROPIN, NORDITROPIN
CELLCEPT 7/1/2009 DELETION TIER 3 MYCOPHENOLATE
SAVELLA 7/15/2009 ADDITION TIER 3 LYRICA
BYSTOLIC 7/15/2009 ADDITION TIER 3 ATENOLOL, METOPROLOL
TEGRETOL XR 8/1/2009 DELETION TIER 3 CARBAMAZEPINE XR
EXFORGE HCT 8/1/2009 ADDITION TIER 3 HYDROCHLOROTHIAZIDE, AMLODIPINE, BENICAR
TRILIPIX 8/1/2009 ADDITION TIER 3 FENOFIBRATE
RYZOLT ER 8/1/2009 ADDITION TIER 3 TRAMADOL
MOXATAG ER 8/15/2009 DELETION NO COVERAGE AMOXICILLIN
VIMPAT 8/15/2009 ADDITION TIER 3 ZONISAMIDE, TOPIRAMATE, LAMOTRIGINE
URSO, URSO FORTE 9/1/2009 ADDITION TIER 3 URSODIOL
LAMICTAL ODT 9/1/2009 ADDITION TIER 3 LAMOTRIGINE

* May require prior authorization.

Members should always consult with their provider before making any changes to their drug treatment plan.

Preferred Drug List Definitions:
Tier 1: Preferred generic medications that are available at the lowest copayment
Tier 2: Preferred brand name medications that are available at a median copayment
Tier 3: Non-preferred medications that are available at the highest copayment
Tier 4: Specialty and injectible drugs at the benefit described in your benefit summary
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